Forms

Print out the forms you need at your home or office so you can fill them out and bring them to your appointment.

If you would like, we can make copies for you also. You can fill out the forms here.

Please arrive at least 15-minutes before your appointment.

If you need help in completing your paperwork, please call us prior to your appointment and arrive at least 25-minutes before your scheduled time. (316-295-4800)

Call us before your visit

When you make your initial appointment, please ask which forms and information you need to bring with you. If you like, you can fill out the forms in our office. Let our receptionist know what you prefer.

If you need a PDF reader, you can download Adobe here. (Be sure to uncheck all the addons with this free download.)

If applicable, we will file the appropriate paperwork with your insurance provider or government agency for payment. Be sure to bring the proper information so we can file for you.

Registration Forms Package

MH Patient Registration Package

• New Patient Registration
• MH Concerns Checklist
• MH History

Play Therapy Forms

Child Play Therapy Background Forms

• Child Background Information

Mental Health Forms Package

MH Patient Agreements & Polcies

• Fee Schedule
• Services Agreement
• Privacy Practices & Consent
• Patient’s Rights
• Grievance Policy

Substance Abuse Forms Package

SA-Substance-Abuse-Package-2024 03 19

• SA Acknowledgement
• SA Concerns List
• SA Personal Substance Use History
• SA Depression Scale
• SA Release of Information
• SA SASSI DSM-5 Screening Inventory
• SA TCU Drug Screen Use
• SA Treatment Contract

Grievance Policy & Form Package

Grievance Policy and Form

• Grievance Policy
• Grievance Form

Remember to bring your government identification card and current health insurance information.

Call us anytime if you have questions. (316-295-4800)

Our office hours are Monday through Friday from 8am to 9pm. Call anytime to leave a message.